Author + information
- Received August 5, 2019
- Revision received December 19, 2019
- Accepted January 2, 2020
- Published online April 6, 2020.
- Steven A. Guidera, MDa,∗ (, )
- Sudhir Aggarwal, MD, PhDb,
- J. Doyle Walton, MDa,
- David Boland, MDa,
- Roy Jackel, MDb,
- Jeffrey D. Gould, MDb,
- Brooke Kearins, CRNPb,
- Joseph McGarvey Jr., MDa,
- Yan Qi, MDb and
- Brian Furlong, BAc
- aDivision of Cardiology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania
- bDivision of Neurology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania
- cDepartment of Radiology, Lehigh Valley Hospital, Allentown, Pennsylvania
- ↵∗Address for correspondence:
Dr. Steven A. Guidera, Doylestown Hospital, 315 West State Street, Doylestown, Pennsylvania 18901.
Objectives The aim of this study was to determine the feasibility of establishing a mechanical thrombectomy (MT) program for acute ischemic stroke in a community hospital using interventional cardiologists working closely with neurologists.
Background American Heart Association/American Stroke Association 2018 guidelines give a Class I (Level of Evidence: A) recommendation for MT in eligible patients with large vessel occlusion stroke. Improvement in neurological outcomes with MT is highly time sensitive. Most hospitals do not have trained neurointerventionalists to perform MT, leading to treatment delays that reduce the benefit of reperfusion therapy.
Methods An MT program based in the cardiac catheterization laboratory was developed using interventional cardiologists with ST-segment elevation myocardial infarction teams.
Results Forty patients underwent attempted MT for acute ischemic stroke. An additional 5 patients who underwent angiography did not undergo attempted thrombectomy, because of absence of target thrombus (n = 4) or unsuitable anatomy (n = 1). Median National Institutes of Health Stroke Scale score prior to MT was 19 and at discharge was 7. TICI (Thrombolysis In Cerebral Infarction) grade 2b or 3 flow was restored in 80% of patients (32 of 40). At 90 days, 55% of patients (22 of 40) were functionally independent (modified Rankin score ≤2). In-hospital mortality was 13% (5 of 40). Symptomatic intracranial hemorrhage occurred in 15% of patients (6 of 40). Major vascular complications occurred in 5% of patients (2 of 40).
Conclusions MT can be successfully performed by interventional cardiologists with carotid stenting experience working closely with neurologists in hospitals lacking formally trained neurointerventionists. This model has the potential to increase access to timely care for patients with acute ischemic stroke.
Mr. Furlong is a consultant for ConsignMed Consultants. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 5, 2019.
- Revision received December 19, 2019.
- Accepted January 2, 2020.
- 2020 American College of Cardiology Foundation
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